Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301099761 | MI |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | C162071 | CA |
NPI | 1205015468 |
---|---|
Provider Name | Kunal P Kalra |
First Address | Victorville, CA 92395-8321 |
Second Address | Victorville, CA 92395-8321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 19/06/2020 |